Nurse Case Manager II

Elevance Health • Indianapolis, IN

3d • Remote

About The Position

The Nurse Case Manager II provides care management, within the scope of licensure, for members with complex and chronic care needs. The role assesses, develops, implements, coordinates, monitors, and evaluates care plans to optimize members’ health care across the care continuum. Duties may be performed telephonically or on-site, including at hospitals for discharge planning.

The role is primarily virtual, with required in-person training sessions. Candidates must reside within reasonable commuting distance of a posting location unless an accommodation is granted as required by law; alternate locations may be considered when candidates are within commuting distance of an office. The schedule is Monday through Friday: four days per week from 9:00 AM to 5:30 PM and one day per week from 11:30 AM to 8:00 PM, local time.

This is a non-management exempt position on the Licensed Nurse job family. Elevance Health describes its total rewards as including merit increases, paid holidays, paid time off, incentive bonus programs, medical, dental, vision, short- and long-term disability benefits, a 401(k) with match, a stock purchase plan, life insurance, wellness programs, and financial education resources; eligibility and applicable terms vary.

Requirements

• A bachelor’s degree in a health-related field and at least 5 years of clinical experience, or an equivalent combination of education and experience.
• Current, unrestricted RN license in applicable state(s).
• Multi-state licensure is required when providing services in multiple states.

Nice To Haves

• Certification as a Case Manager.
• Bachelor’s degree in a health- or human-services-related field.
• Active Registered Nurse Compact License.

Responsibilities

• Ensure members have access to services appropriate to their health needs.
• Conduct assessments to identify individual needs and develop specific care management plans with objectives and goals.
• Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements, as appropriate.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate the effectiveness of care management plans and modify them as necessary.
• Interface with Medical Directors and Physician Advisors to develop care management treatment plans.
• Negotiate reimbursement rates, as applicable.
• Help resolve provider, claims, or service issues.
• Assist with developing utilization and care management policies and procedures.
• Perform duties telephonically or on-site, including hospital discharge planning.

Benefits

• Comprehensive benefits package, subject to eligibility requirements.
• Incentive and recognition programs.
• Equity stock purchase program.
• 401(k) contribution.
• Merit increases.
• Paid holidays.
• Paid time off.
• Incentive bonus programs, unless covered by a collective bargaining agreement.
• Medical benefits.
• Dental benefits.
• Vision benefits.
• Short- and long-term disability benefits.
• 401(k) with match.
• Stock purchase plan.
• Life insurance.
• Wellness programs.
• Financial education resources.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level